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Also remember, as soon as the patient goes unconscious, this airway is their primary risk. As soon as they go unconscious, the tongue slopes to the back of the throat, the airway becomes occluded, stomach content starts to run forward open into the back of the throat, and if we're not monitoring it carefully we very quickly have a cardiac arrest or a drowning, choking, or asphyxiated casualty.

So, when patient's on spinal boards, when patient's on scoops, when patients are lying flat on their back and are unconscious, the airway is your main priority; airway before breathing, before circulation. The only thing that supersedes that obviously is a catastrophic bleed where they will bleed to death very very quickly from an arterial bleed, so that takes priority. But airway is always gonna be the starting point for any assessment and it should also be the finishing point. Because when we finish the top-to-toe survey, we come back to make sure the airway has not changed in any way, shape, or form. If we do anything that may change the way the airway is working, we must always go back and double-check it.

One of the easiest and simple ways to keep a check on an airway while you are doing your assessment is talking to your casualty. If they are talking back to you, they are talking appropriately, they are not struggling to breathe, keep talking because all the time you are talking, you are monitoring their airway. If anything changes, you will pick it up immediately. But if you do not talk to your patient, if you do not communicate with your patient, they can very quickly arrest, occlude their airway, and you do not even notice it has happened for possibly 30, 40, 50 seconds. That is 30, 40, 50 seconds longer than it would have taken you if you had been talking and communicating with your patient at all times, plus it reassures them their breathing is always easier if they are confident, if they are calm, if they are feeling involved, and if they are not frightened. Communication is the key to all assessments. Tell your patient what you are doing, talk to your patient while you are doing it, and tell them what you find. But bear in mind we do not want to frighten the patient.

So finally, we are gonna have a look at, very briefly, one or two of the conditions that we have talked about in a little bit more depth. Firstly, we have got the pneumothorax. Pneumothorax is where air leaks through the chest wall into the cavity itself, from things like gunshot wounds, stabbing injuries, stabbing situations where we have got a hole from the outside to the inside. Air, as it comes into the lung, will leak out of the lung and out of the chest wall itself, and then as we breathe the opposite way or relax, it sucks back in and fills the cavity; the lung will deflate. For this type of injury, we put a one-way seal, an Asherman Chest Seal or a Russell Chest Seal to allow a one-way valve to allow air out but not air back in again.

We can have a tension pneumothorax. Tension pneumothorax is where there is no hole to the outside of the chest, but there is a hole in the lung itself. That leaks air out of the lung into the cavity around the lung where the lung sits in and starts to deflate the lung itself. Those can happen also, especially with the young and especially with people who have grown quite tall quite quickly, as what we call a spontaneous pneumothorax where the lung literally can just form a hole and burst. As I said, it tends to happen in tall, lanky young people who have grown fast and the tissue has become delicate and burst. They could also happen the same way with things like blast injuries and explosions and vacuum problems where a bomb or an explosion has gone off, and actually what we call the paper bag effect where the lung itself just pops due to pressure changes.

Hemothorax, basically where we have got blood leaking into the lung itself and filling up. These are the ones you will see where basics doctors, may have seen it on TV, may have seen it in RTCs, crashes and this type of stuff where doctors penetrate through the side of the chest wall put a tube in and drain the blood out. Because unless we get the air out and the blood out, they all affect the way the lung functions. The way the lungs function affects the way the heart beats, and if there is not enough oxygen going through your lung and your circulatory system due to a blockage, due to a burst, due to a puncture, due to a bleed, there is not enough oxygen going around your system, eventually it will turn into a fatal incident. We need to have that oxygen going in and functioning properly to keep the patient alive. So look at what you can see, look at the way the position of the patient is, look at what you can hear, or listen to what you can hear with the chest itself. Remember to percuss for sound, listen with stethoscopes and make your decisions from the mechanism, from the trauma that has caused or potentially caused the internal problems themselves.